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. 2025 Feb 13:81:103109.
doi: 10.1016/j.eclinm.2025.103109. eCollection 2025 Mar.

The prognostic value of peritoneal metastases in patients with gastric cancer: a nationwide population-based study

Niels A D Guchelaar  1 , Micha J de Neijs  1   2 , Bo J Noordman  2 , Heilida E C Graaf  1 , Irene E G van Hellemond  3 , Pieter C van der Sluis  2 , Esther Oomen-de Hoop  1 , Sjoerd M Lagarde  2 , Rob H A Verhoeven  4   5   6 , Stijn L W Koolen  7 , Misha D P Luyer  8 , Ignace H J T de Hingh  8   9 , Hanneke W M van Laarhoven  5   6 , Bianca Mostert  1 , Bas P L Wijnhoven  2 , Ron H J Mathijssen  1
Affiliations

The prognostic value of peritoneal metastases in patients with gastric cancer: a nationwide population-based study

Niels A D Guchelaar et al. EClinicalMedicine. .

Abstract

Background: The peritoneum is a common metastatic site in gastric cancer. The prognosis of synchronous peritoneal metastases compared to other metastatic sites in gastric cancer remains understudied. This study aims to evaluate the impact of peritoneal metastases on survival in patients with metastatic gastric cancer.

Methods: Patients with gastric cancer and synchronous metastases between 2015 and 2020 were identified from the nationwide Netherlands Cancer Registry. Patients were categorized based on the site of metastases. Median overall survival (OS) was calculated for each metastatic site group. Multivariable Cox regression analyses were performed to evaluate the association between patient, tumour, and treatment characteristics, including the impact of systemic therapy, on OS.

Findings: A total of 4072 patients were included, of whom 1835 (45.1%) had peritoneal metastases. Of these, 58.1% had isolated peritoneal metastases. For patients with metastatic gastric cancer treated with systemic therapy, the median OS was 9.0 months (95% confidence interval (CI): 8.6-9.5), compared to 1.7 months (95% CI: 1.7-1.9) for treatment-naïve patients, who received only palliative care. The survival for patients with isolated peritoneal metastases (4.4 months, 95% CI: 4.0-4.8 months) was similar to those with isolated non-peritoneal metastases (4.6 months, 95% CI: 4.2-5.1 months, adjusted HR: 0.94, 95% CI: 0.86-1.03, p = 0.185). Systemic therapy was associated with comparable survival in patients with peritoneal metastases and those with metastases at other sites.

Interpretation: This study demonstrates that there is no statistically significant difference in survival between patients with isolated peritoneal metastases and those with isolated non-peritoneal metastases in gastric cancer. Our findings emphasize the unique prognostic landscape for peritoneal metastases in gastric cancer, underscoring the need for disease-specific evaluations, rather than relying on assumptions derived from other cancer types.

Funding: None.

Keywords: Chemotherapy; Gastric cancer; Metastases; Peritoneal metastases; Prognosis.

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Conflict of interest statement

Rob Verhoeven received research grant from BMS, performed consultancy for Daichi Sankyo, all paid to institution. Misha Luyer received consulting fees from Medtronic and Galvani. Ignace de Hingh received unrestricted research grants from Roche and RanD, all paid to institution. Hanneke van Laarhoven received consulting fees from Amphera, Astellas, Beigene, Daiichy, and Myeloid, received research funding, medication supply, and/or other research support from Amgen, AstraZeneca, Auristone, BMS, Incyte, Merck, ORCA, and Servier, and received funding for a speaker role from Astellas, AstraZeneca, BMS, Benecke, Daiichi-Sankyo, JAAP, Medtalks, Novartis, Servier, and Travel Congress Management. Bianca Mostert received consulting fees from Lilly, Amgen, Servier, BMS, AstraZeneca, and research funding from Sanofi, Pfizer and BMS. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Overall survival in patients with synchronous metastatic gastric cancer and one metastatic site. The numbers in the table correspond to the number of patients at risk at each time interval since diagnosis. The p-value represent the result of the log-rank test comparing the Kaplan–Meier survival curves of the different groups. Abbreviation: CI, confidence interval.
Fig. 2
Fig. 2
Overall survival in patients with synchronous metastatic gastric cancer divided by peritoneal status and other metastatic sites. The numbers in the table correspond to the number of patients at risk at each time interval since diagnosis. The p-value represent the result of the log-rank test comparing the Kaplan–Meier survival curves of the different groups. Abbreviation: CI, confidence interval.
See this image and copyright information in PMC

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